BACKGROUND: All-trans-retinoic acid induces complete remission in acute promyelocytic leukemia. However, it is not clear whether induction therapy with all-trans-retinoic acid is superior to chemotherapy alone or whether maintenance treatment with all-trans-retinoic acid improves outcome. METHODS:Three hundred forty-six patients with previously untreated acute promyelocytic leukemia were randomly assigned to receive all-trans-retinoic acid or daunorubicin plus cytarabine as induction treatment. Patients who had a complete remission received consolidation therapy consisting of one cycle of treatment identical to theinduction chemotherapy, then high-dose cytarabine plus daunorubicin. Patients still in complete remission after two cycles of consolidation therapy were then randomly assigned to maintenance treatment with all-trans-retinoic acid or to observation. RESULTS: Of the 174 patients treated withchemotherapy, 120 (69 percent) had a complete remission, as did 124 of the 172 (72 percent) given all-trans-retinoic acid (P=0.56). When both induction and maintenance treatments were taken into account, the estimated rates of disease-free survival at one, two, and three years were 77, 61, and 55 percent, respectively, for patients assigned to chemotherapy then all-trans-retinoic acid; 86, 75, and 75 percent for all-trans-retinoic acid then all-trans-retinoic acid; 75, 60, and 60 percent for all-trans-retinoic acid then observation; and 29, 18, and 18 percent for chemotherapy then observation. By intention-to-treat analysis, the rates of overall survival at one, two, and three years after entry into the study were 75, 57, and 50 percent, respectively, among patients assigned to chemotherapy, and 82, 72, and 67 percent among those assigned to all-trans-retinoic acid (P= 0.003). CONCLUSIONS: All-trans-retinoic acid as induction or maintenance treatment improves disease-free and overall survival as compared with chemotherapy alone and should be included in the treatment of acute promyelocytic leukemia.
RCT Entities:
BACKGROUND:All-trans-retinoic acid induces complete remission in acute promyelocytic leukemia. However, it is not clear whether induction therapy with all-trans-retinoic acid is superior to chemotherapy alone or whether maintenance treatment with all-trans-retinoic acid improves outcome. METHODS: Three hundred forty-six patients with previously untreated acute promyelocytic leukemia were randomly assigned to receive all-trans-retinoic acid or daunorubicin plus cytarabine as induction treatment. Patients who had a complete remission received consolidation therapy consisting of one cycle of treatment identical to the induction chemotherapy, then high-dose cytarabine plus daunorubicin. Patients still in complete remission after two cycles of consolidation therapy were then randomly assigned to maintenance treatment with all-trans-retinoic acid or to observation. RESULTS: Of the 174 patients treated with chemotherapy, 120 (69 percent) had a complete remission, as did 124 of the 172 (72 percent) given all-trans-retinoic acid (P=0.56). When both induction and maintenance treatments were taken into account, the estimated rates of disease-free survival at one, two, and three years were 77, 61, and 55 percent, respectively, for patients assigned to chemotherapy then all-trans-retinoic acid; 86, 75, and 75 percent for all-trans-retinoic acid then all-trans-retinoic acid; 75, 60, and 60 percent for all-trans-retinoic acid then observation; and 29, 18, and 18 percent for chemotherapy then observation. By intention-to-treat analysis, the rates of overall survival at one, two, and three years after entry into the study were 75, 57, and 50 percent, respectively, among patients assigned to chemotherapy, and 82, 72, and 67 percent among those assigned to all-trans-retinoic acid (P= 0.003). CONCLUSIONS:All-trans-retinoic acid as induction or maintenance treatment improves disease-free and overall survival as compared with chemotherapy alone and should be included in the treatment of acute promyelocytic leukemia.
Authors: Harry Iland; Ken Bradstock; John Seymour; Mark Hertzberg; Andrew Grigg; Kerry Taylor; John Catalano; Paul Cannell; Noemi Horvath; Sandra Deveridge; Peter Browett; Tim Brighton; Li Chong; Francisca Springall; Juliet Ayling; Alberto Catalano; Shane Supple; Marnie Collins; Juliana Di Iulio; John Reynolds Journal: Haematologica Date: 2011-10-11 Impact factor: 9.941
Authors: Peter H Wiernik; Zhuoxin Sun; Holly Gundacker; Gordon Dewald; Marilyn L Slovak; Elisabeth Paietta; Haesook T Kim; Frederick R Appelbaum; Peter A Cassileth; Martin S Tallman Journal: Med Oncol Date: 2012-05-22 Impact factor: 3.064
Authors: Ulka Vaishampayan; Lance K Heilbrun; Ralph E Parchment; Vikash Jain; James Zwiebel; Ramesh R Boinpally; Patricia LoRusso; Maha Hussain Journal: Invest New Drugs Date: 2005-03 Impact factor: 3.850
Authors: Steven E Coutre; Megan Othus; Bayard Powell; Cheryl L Willman; Wendy Stock; Elisabeth Paietta; Denise Levitan; Meir Wetzler; Eyal C Attar; Jessica K Altman; Steven D Gore; Tracy Maher; Kenneth J Kopecky; Martin S Tallman; Richard A Larson; Frederick R Appelbaum Journal: Br J Haematol Date: 2014-02-14 Impact factor: 6.998